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Sample Form 2

PF Form 2

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king_electrical
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36K views

Sample Form 2

PF Form 2

Uploaded by

king_electrical
Copyright
© © All Rights Reserved
Available Formats
Download as PDF or read online on Scribd
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FORM 2 (Revised) NOMINATION AND DECLARATION FORM (For Unexompted / Exempted Estabthments) Declaration and Nomination Form under the Employes Provident Funds & Employees’ Pension Scheme (Paragraph 23 and 61(1) ofthe Employees’ Provident Fund Scheme, 1952 & Paragraph 18 ‘ofthe Employees’ Pension Scheme, 1995) 4 i HC pleas a ppicnsle a baectern:_tusplayeiss hoe _4 Sex * nob db Blaut) 5. Maal Status: “ 6 AcsountNo, : = ee canara to be fourd Tarporwy: do be mentors PART A (EPF) | hereby nominate the person (s) {cancel the nomination made by me previously and nominate the person (s) mentioned below receive the amount standing to my credit in the Employees’ Provident Fund, in the eventof my Death Totalemount | thenomineeis ki tenet! | Srna ieee aan | Remcg| oe | cate, | imotnes ‘nominee's MAES. inProvident | 138 ofthe guard- on member Fundtobe | lanwhomayrece- fot ere || camera ‘tonnes | during tre minory| ‘tromines 1 2 3 ‘ 5 ° | Nonunce de)| Nemcacent fot ]] Nomi wep [9 aclolass punt] B08 ppotd [som TJ 04 = Nonunee 2 Ly usp) gun | fawed Cast 4. *Certied that | have no family as defined in para 2 (g) of the Employees’ Provident Fund Scheme, 1852 and shoul | ‘acquire femly hereafter tho above nominaion shouldbe deemed a8 canceled 2. *Cortfed that my father / mothers are dependent upon me. Jean ate aTaTe ee Spare a tae kre atta BOSE, PART B (EPS) (Para 18) ' hereby furnish below particulars of the members of my family who would be eligible to receive widow children pension in tho event of my death, Sars Se a ee No, Name ‘Address Birth member i : . i . ibs crn a) Wt TR ce ead (oes Slt Des d “Certified that | have no family as defined in psta2 (vil) of Employees’ Pension Scheme, 1995 and ‘should acquire a family hereafter | shal furnish partculare thereon inthe above form. {hereby nominate the folowing person, for racelving the monthly widow pension (admissible under para 162(a) (i) &@ in event of my death without leaving any eligiie family member for recolving pension. = Name & address of the nominee Date ofBith | Relationship with the member eae fprovicle nominees nous 4 address T ‘fotki fracthA/ Bail a55 Qegno tion spanesingioes rofthie subsorbe? ‘CERTIFICATE BY EMPLOYER Certified that the above declaration and nomination has been signed!/thumb impressed before me by ShiSroun_ ‘eployedinmy establishment afterhelshe nas read the enivies/envies have been ead over to hinuhor by rhe and gol confirmed by him/her, ‘Signature ofthe employer or other ‘authorised Officers ofthe establishment: Designation Name and address ofthe Factory! Estabishmentorrubber stamp thereat:

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